About diabetes complications

In diabetes care most emphasis is put on optimizing blood sugar. Since persistent high blood sugar may lead to unwanted negative health effects (complications), diabetes health care puts strong emphasis on (helping) preventing high blood sugar and complications, and detecting early warning signs.
Most people with diabetes know about the potential negative health effects of persistent high blood sugar. They know about the potential risks of visual impairment, kidney failure or even amputations. And many have heard of or know someone, who has been confronted with diabetes complications.
It is good to know about the potential dangers of persistent high blood sugars, and about how to increase the chances of preventing complications.
It is also good to be realistic about the chances of developing these complications. Fortunately, most people with diabetes will NOT develop these serious complications.
Most people are aware of the dangers of persistent high glucose levels, and will use it to a good end. They are aware, but not negatively influenced by this awareness. They are trying their best to prevent persistent high blood sugar, and do not ruminate (too much) about future complications.
However, some people worry about diabetes complications more than is good/healthy for them.
If you worry about high blood glucose levels and/or complications too much it is good to educate yourself about the actual risks of developing diabetes complications. Your health care professional monitors the (lack of) progress of these complications and is able to tell you more about your personal risk.
Apart from education about (un)realistic chances of complications, it is best to focus on the things you can influence or change NOW. Even when you are faced with an increased chance of developing complications in the future, there are many things you can do NOW that help you in trying to make your health situation as good as possible: monitor your glucose, being compliant to your insulin regimen, eating healthy, doing exercise. You can even ask your health professional which health behaviours are most influential in the (prevention of the) development of complications.
Being fearful will cost you energy. Energy that is lost, without any effect. See whether you can change this negative energy into effective energy, by changing your self-management for the best!

Worrying about low blood sugars

Many people with diabetes worry about having low blood sugar (hypoglycaemia, or ‘hypo’s’).
To a certain extent, worrying about low blood sugar is a normal and healthy phenomenon in all diabetes patients on insulin (or other blood glucose lowering medication). However, in some people normal and healthy worries develop into hindering anxieties, that influence their blood sugars and quality of life. Often, these anxieties develop after having experienced a serious hypo, needing help from others, and/or being unconscious. But in some people these hindering anxieties might also develop without having experienced a serious hypo.

Many people with fear of hypoglycaemia worry about:

-having a hypo while asleep (or even dying from a hypo in their sleep)
-losing consciousness in public, while driving or being alone at home
-needing help from others, attracting unwanted attention

In some people these anxieties are so intense that they will make sure their blood sugar never drop below a certain level. They might eat some extra carbs before going to bed, before/while driving, or before going out, even when their blood sugar don’t really ‘need’ an extra snack. Or otherwise, people might use less insulin than they should, just to make sure that their blood sugar won’t drop. Some might check their blood sugars excessively, to monitor potential blood sugar drops.
These are all common behavioural reactions to anxiety, and are called ‘’safety behaviours’’. In the short term, these safety behaviours help to prevent/decrease anxiety. However, in the long term, these behaviours make people more insecure about low blood sugar, and help to develop even more anxiety.
That is why it is so important to limit the ‘’safety behaviours’’ to a healthy and rational amount.

If you recognize these anxieties and safety behaviours, there are a few steps to take:

  • it is good to let others know about it. Best would be to inform your partner/significant other, as well as your diabetes health care professional (s).
  • make a list of the questions/worries you have about hypo’s. Explain what your fears are about
  • make a list of the specific safety behaviours that you perform to reduce your anxiety
  • let a diabetes health care professional educate you about hypoglycaemia
  • let a diabetes health care professional help you in making a stepwise plan on how to limit these safety behaviours

Worst Case Scenario: Diabetic Coma

Diabetic coma is an emergency. You cannot be prepared in advance. If you have the feeling of an extreme high or low blood sugar you should call your local emergency number. You need to ensure help before you pass out.

If there is a person with you instruct him/her about it. If this person is familiar with diabetes care he/she should:

  1. Test your blood sugar.
  2. If the blood sugar level is lower than 70 mg/dL (3.9 mmol/L), administer an injection of glucagon. If glucagon isn’t available, rub glucose gel, honey or non-sugar-free syrup on the inside of the unconscious person’s cheek. No insulin should be given!
  3. If the blood sugar level is above 70 mg/dL, wait for medical help to arrive. Don’t give sugar to someone whose blood sugar isn’t low.

Let the emergency care team know about the diabetes and what steps have been taken, if any.

Low blood sugar

Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar (shakiness, nervousness or anxiety, sweating chills and clamminess, irritability or impatience, confusion, rapid heartbeat, dizziness, hunger and nausea, sleepiness, blurred vision, tingling or numbness in the lips or tongue, headaches, weakness or fatigue, anger or sadness, lack of coordination, nightmares or crying out during sleep, seizures, unconsciousness).

Eat or drink something that will quickly raise your blood sugar level, fruit juice, etc.

  • Consume 15-20 grams of glucose or simple carbs.
  • Check your blood glucose level once again after 15 minutes
  • If hypoglycemia continues, repeat the actions from the beginning.

Once your blood glucose is normal eat a small snack if the next meal is more than one hour away.

Find more info on low blood sugar here.

Hyperglycemic Hyperosmolar Non-ketotic Syndrome (HHNS)

HHNS only occurs when diabetes is uncontrolled. In order to avoid HHNS you have to check your blood sugar on a regular basis. Your doctor or a diabetes educator can help you with this: you may learn the techniques and the personal interpretation of results. If sick, you will check your blood sugar more often, and drink a glass of liquid every hour. You can build your sick day plan with your healthcare team.

Call your doctor or seek immediate medical care of you have signs or symptoms of HHNS.

Diabetic ketoacidosis: over-the-counter ketones test

You can easily find ketone tests at your pharmacy. Ask your doctor about testing and recording methods. Urine tests are simple, but to get good results you have to follow directions carefully.

Here’s how most urine tests go:

  • Get a sample of your urine in a clean container.
  • Place the strip in the sample (you can also pass the strip through the urine stream).
  • Gently shake excess urine off the strip.
  • Wait for the strip pad to change color. The directions will tell you how long to wait.
  • Compare the strip pad to the color chart on the strip bottle. This gives you a range of the amount of ketones in your urine.
  • Record your results

Small or trace amounts of ketones may mean that ketone buildup is starting. You should test again in a few hours.

Moderate or large amounts are a danger sign. They can poison the body. Never exercise when your urine checks show moderate or large amounts of ketones and your blood glucose is high. These are signs that your diabetes is out of control.

Diabetic ketoacidosis is a life-threatening medical condition. If you develop mild signs and symptoms, contact your doctor immediately.

If your doctor suspects diabetic ketoacidosis he/she will do some tests. Sometimes additional tests may be needed to help determine what triggered the episode of diabetic ketoacidosis or what damage the ketoacidosis may have caused.

Blood tests used in the diagnosis of diabetic ketoacidosis will measure: blood sugar level, ketone level, and blood acidity. Other tests may include: blood electrolyte tests, urinalysis, chest X-ray, or an electrocardiogram.

If you’re diagnosed with diabetic ketoacidosis, you may be treated in the emergency room or admitted to the hospital. Treatment usually involves a three-pronged approach: fluid replacement, electrolyte replacement, and insulin therapy.


Your blood sugar level is an essential measure for your health. You have to learn how to monitor it and to make it part of your daily routine. Your doctor or a diabetes educator can help you with this.

An appropriate diet and some physical activity can help you lower your blood glucose level.

But there are special cases as well. If you have a high level of blood sugar you may check for ketones in your urine. If you have ketones you should not exercise. This may cause the opposite effect.

If you think you have hyperglycemia contact your doctor.

More info on hyperglycemia can be found here.